title: Fulminant septicemia of Bacillus cereus resistant to carbapenem in a patient with biphenotypic acute leukemia.
abstract: We report a case of fulminant septicemia with Bacillus cereus resistant to carbapenem. A 33-year-old man was suffering from febrile neutropenia (FN) on day 15 after the start of remission-induction therapy for biphenotypic acute leukemia under gut decontamination with polymyxin B and nystatin. Meropenem, a carbapenem, was administered according to the guideline for FN. Two days later (on day 17), he complained of severe abdominal pain, lost consciousness, went into sudden cardiopulmonary arrest, and died. Autopsy showed multiple spots of hemorrhage and necrosis caused by bacterial plaque in the brain, lungs, and liver. B. cereus was isolated from a blood sample obtained in the morning on day 17 and it was after his death that the isolated B. cereus was revealed to be resistant to carbapenem. B. cereus obtained from blood samples has been reported to be usually sensitive to carbapenem and also to vancomycin, new quinolones, and clindamycin. If B. cereus resistant to carbapem increases, our method of gut decontamination with polymyxin B and nystatin may have to be changed to one containing a new quinolone for the prevention of septicemia. Careful watching to determine whether B. cereus resistant to carbapem increases may be also important for empiric therapy, because carbapenem is often selected as the initial therapy for FN in patients with severe neutropenia.
authors.affiliation: Department of Hematology and Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Osaka, 537-8511, Japan.
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Kiyomizu
authors.forename: Toshinari
authors.initials: T
authors.lastname: Yagi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Ryota
authors.initials: R
authors.lastname: Minami
authors.forename: Akira
authors.initials: A
authors.lastname: Tanimura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Karasuno
authors.forename: Akira
authors.initials: A
authors.lastname: Hiraoka
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001409:Bacillus cereus / Q000187:drug effects* / Q000302:isolation & purification; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D001933:Brain Stem / Q000382:microbiology / Q000473:pathology; D015780:Carbapenems / Q000494:pharmacology / Q000627:therapeutic use*; D005334:Fever / Q000188:drug therapy; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D015456:Leukemia, Biphenotypic, Acute / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008099:Liver / Q000382:microbiology / Q000648:ultrastructure; D008168:Lung / Q000382:microbiology / Q000648:ultrastructure; D008297:Male; D008826:Microbial Sensitivity Tests; D009503:Neutropenia / Q000188:drug therapy; D012074:Remission Induction; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems